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年龄相关性变化对心血管疾病患者初级保健服务和药物处方的影响。

Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease.

机构信息

Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney 2050, Australia.

Department of Cardiology, Concord Hospital, Sydney 2139, Australia.

出版信息

Int J Environ Res Public Health. 2022 Aug 29;19(17):10761. doi: 10.3390/ijerph191710761.

Abstract

As population aging progresses, demands of patients with cardiovascular diseases (CVD) on the primary care services is inevitably increased. However, the utilisation of primary care services across varying age groups is unknown. The study aims to explore age-related variations in provision of chronic disease management plans, mental health care, guideline-indicated cardiovascular medications and influenza vaccination among patients with CVD over differing ages presenting to primary care. Data for patients with CVD were extracted from 50 Australian general practices. Logistic regression, accounting for covariates and clustering effects by practices, was used for statistical analysis. Of the 14,602 patients with CVD (mean age, 72.5 years), patients aged 65-74, 75-84 and ≥85 years were significantly more likely to have a GP management plan prepared (adjusted odds ratio (aOR): 1.6, 1.88 and 1.55, respectively, < 0.05), have a formal team care arrangement (aOR: 1.49, 1.8, 1.65, respectively, < 0.05) and have a review of either (aOR: 1.63, 2.09, 1.93, respectively, < 0.05) than those < 65 years. Patients aged ≥ 65 years were more likely to be prescribed blood-pressure-lowering medications and to be vaccinated for influenza. However, the adjusted odds of being prescribed lipid-lowering and antiplatelet medications and receiving mental health care were significantly lowest among patients ≥ 85 years. There are age-related variations in provision of primary care services and pharmacological therapy. GPs are targeting care plans to older people who are more likely to have long-term conditions and complex needs.

摘要

随着人口老龄化的发展,心血管疾病(CVD)患者对初级保健服务的需求不可避免地增加。然而,不同年龄段患者对初级保健服务的利用情况尚不清楚。本研究旨在探讨不同年龄段就诊于初级保健的 CVD 患者接受慢性病管理计划、心理健康护理、指南推荐的心血管药物和流感疫苗接种的情况与年龄的相关性变化。从 50 家澳大利亚全科诊所中提取了 CVD 患者的数据。使用逻辑回归,根据诊所进行协变量和聚类效应的校正,进行统计分析。在 14602 名 CVD 患者(平均年龄 72.5 岁)中,65-74 岁、75-84 岁和≥85 岁的患者更有可能制定全科医生管理计划(调整后的优势比(aOR):1.6、1.88 和 1.55,分别为 <0.05),有正式的团队护理安排(aOR:1.49、1.8、1.65,分别为 <0.05),并对两者进行评估(aOR:1.63、2.09、1.93,分别为 <0.05),而<65 岁的患者则不然。≥65 岁的患者更有可能接受降压药物治疗和流感疫苗接种。然而,调整后的血脂降低和抗血小板药物治疗以及心理健康护理的可能性在≥85 岁的患者中明显最低。初级保健服务和药物治疗的提供存在与年龄相关的差异。全科医生针对的是年龄较大的人群,这些人更有可能患有长期疾病和复杂的需求。

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